What is cognitive behaviour therapy (CBT)?
Stemming from psychological theories existing in the 1950’s, CBT combines the basic principles of Cognitive Therapy with Behavioural Therapy to create Cognitive behaviour therapy (CBT). CBT is a short-term, goal-oriented type of psychotherapy that emphasises the impact of one’s cognition (thoughts) on one’s emotion, behaviour and overall psychological wellbeing. More specifically, how negative thoughts can lead to feelings of distress and unhelpful behaviours. The aim of CBT is to replace pessimistic thoughts with more positive and realistic thoughts, hence the cognitive component, but to also encourage patients to do step out of their comfort zone, hence the behavioural component. Amongst mental health practitioners, CBT is highly regarded due to its strong empirical support, with extensive research proving it’s efficacy. In fact, while CBT is known for treating a range of psychological conditions like anxiety and depression, it has also been shown to aid in coping and managing physical conditions such as chronic pain.
Breaking those bad brain habits!
It is understood that negative or dysfunctional thinking patterns underpin a range of psychological conditions. Such thoughts tend to be automatic, with individuals often not aware of what they are telling themselves. Therefore once such thoughts are identified, one can work towards replacing or challenging them with healthier and more rational self-talk. It is in this way that CBT treats self-defeating thoughts as BAD HABITS, in which like any other habit, can be broken. Examples of automatic negative thoughts and how they can be replaced with positive alternatives are as follows:
Overgeneralising: Which often involves using words such as ‘always’ and ‘never’.
Example: Failing a maths exam and thinking “I’m never going to understand maths”.
Positive/ Realistic Replacement: ‘I can do anything if I put my mind to it, including maths’.
Filtering: Simply focusing on the negative and ignoring the positive.
Example: Getting a bad mark on a maths exam and thinking “I’m so dumb and not good at anything” even though you aced the English exam.
Positive/ Realistic Replacement: ‘I may not be the best at maths, but I sure am good at English!’
Dichotomous Reasoning: also known as ‘all or nothing thinking’, or ‘thinking in black and white’ – which involves thinking in extremes with no middle ground.
Example: Getting a C for a maths exam and thinking ‘I’m terribly bad’ at maths.
Positive/ Realistic Replacement: ‘I did average on my maths exam, and that’s okay.’
Personalising: also known as ‘internal attributions’ whereby one constantly blames one-self instead of looking at the bigger picture.
Example: Your friend Maria is a bit quiet today, so you think ‘Is Maria angry at me? What have I done wrong?’
Positive/ Realistic Replacement: ‘Maria is quiet – maybe she’s tired.’
Catastrophising: which involves thinking the absolute worst-case scenario; an over exaggeration of the chances of something terrible happening.
Example: You fail a maths exam and think ‘I am so dumb, I am never going to be able to get a job, or to make it anywhere in life. How can anyone like me if I’m so worthless? I’m going to die alone.’
Positive/ Realistic Replacement: ‘Ergh…I’m not so good at maths, but I won’t need it for my future career.’
Emotional Reasoning: Mistaking feelings for facts.
Example: I feel unattractive therefore I am unattractive therefore everybody thinks I am unattractive.
Positive/ Realistic Replacement: ‘I feel unattractive, but that doesn’t mean I am unattractive – beauty is subjective’
Mind reading: Making assumptions about how someone feels about you, even though you have no real evidence.
Example: ‘Jackson messaged Hailey so he must like her more than me.’
Positive/ Realistic Replacement: ‘Jackson messaged Hailey, perhaps he had something important to tell her.’
Fortune Telling Error: Anticipating an outcome and believing it to be fact, which can decrease one’s opportunity for change and lead to self-fulfilling prophecies.
Example: Believing you going to fail your maths exam so you decide not to try, skip classes, don’t read the textbook, and then actually fail.
Positive/ Realistic Replacement: Believing you will pass your maths exam, so you study hard and achieve a good mark.
Should Statements: Setting rigid and unrealistic internal or external expectations. It involves using words like ‘should’ or ‘must’.
Example: ‘I should be rich and successful by now.’
Replacement: “I’d like to be rich and successful by now, but it’s okay if I’m not.’
Magnification/ Minimisation: Exaggerating the negative and de-emphasising the positive.
Example: ‘We got along so well, the conversation flowed and we kissed… except I made one really bad joke. He probably thinks I’m a loser and never wants to see me again.’
Positive/ Realistic Replacement: ‘I made a bad joke – but I don’t think he’ll care because the overall date went really well.’
So where do these automatic, negative thoughts come from?
It’s difficult to pinpoint the exact cause of a person’s negative thoughts, however many psychologists believe that negative thought patterns are learned in early childhood, and are linked to one’s assumptions about themselves and the world. For example – a child named Chris may receive minimal attention from his parents, except for when he achieves high marks at school, by which he is provided with much praise. Consequently, Chris may make a dysfunctional assumption that he needs to be a high achiever otherwise he will not be liked or accepted in the world. While this assumption may work in his favour in some regards, such as leading him to being successful and living a comfortable life, it can also lead to problems. Especially if Chris encounters a situation where he fails or cannot achieve as highly as he deems acceptable, resulting in automatic negative thoughts such as “I have completely failed… I’m such a failure…No one is going to like me…I’m worthless”. In this case, Chris’ dysfunctional assumption, which was formed at a young age with minimal life experience and insufficient evidence, is unrealistic. CBT helps individuals to correct irrational thoughts like Chris’ causing them unnecessary distress.
When CBT is useful:
If you are suffering from:
- Obsessive Compulsive Disorder (OCD)
- Low self-esteem
- Anger issues
- Eating disorders
- Chronic pain
What can I expect from CBT treatment?
Short Duration: CBT is advantageous in that it is fairly short term, with treatment generally lasting approximately 5 to 10 months at one session per week. Of course, it may take longer or shorter depending on severity of the patient’s emotional problem(s).
Assessment: You will be asked to fill out questionnaires to identify any distressful symptoms that may require immediate and significant attention, and also to plot your progress.
Education: You will be provided with information about your form of distress from your therapist, and directed to read reputable resources for credible information. Knowledge will lead to increased understanding, enabling the patient to manage their distress symptoms more effectively.
Goal Setting: You will be asked to identify what you would like to achieve from therapy. Your psychologist will provide you with direction, strategies and support to help you to achieve your goals.
Practice: You will practice strategies during therapy to help you execute such strategies in real life. Examples include role-playing an upcoming social situation that you are worried about, getting you to practice realistic and positive self-talk, or practice relaxation techniques.
Homework: You will be given homework sheets to fill out in your own time. Examples include keeping a thought diary to make you more aware of your negative automatic thinking, so that you can stop it in its tracks. You will also be expected to practice strategies learned in therapy in your own time. The more effort you put in applying learnt strategies on a daily basis, the quicker you will feel better!